A minimum of three GPs covering Teesside between midnight and 6am equates to one GP for every 191,000 people. However, the average number of calls received by the out of hours service is 40 on weeknights and 65 at weekends.

Of these, 10% of calls result in primary care centre appointments overnight and 20% result in home visits.

A spokeswoman for Teesside’s PCTs said: “NHS Tees sees patient safety as a top priority and we have a clear legal responsibility to provide safe, high quality, out of hours care.

“We have robust contracts in place to ensure our out of hours provider is meeting national requirements using GPs who are fit to practice to deliver appropriate services.”

The figures relating to out of hours care were published by NHS Tees after an “unlawful killing” verdict by Cambridgeshire Coroner William Morris resulted in a national Department of Health report.

Concluding the inquest into the death of pensioner David Gray, from Manea, the Coroner accused German doctor Daniel Ubani of gross negligence over Mr Gray’s death in 2008 and said “weaknesses remain” in the out-of-hours system, including the use of overseas and locum doctors.

A review led David Colin-Thome at the Department of Health, and Steve Field, chairman of the Royal College of GPs to call for proper inductions for all doctors who have never worked out-of-hours or in the NHS before.

Overall, the review said the quality of care in many areas across the country was “good” but acknowledged the quality of services varies “unacceptably”.

Dr Colin-Thome said: “The quality of out of hours care for most people is better than it was in 2004, but there is unacceptable variation in how services are implemented and monitored around the country.

“However, I am confident that by implementing the recommendations from our report, the system can be strengthened and vastly improved.”